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. 2021 Sep:39:101085.
doi: 10.1016/j.eclinm.2021.101085. Epub 2021 Aug 20.

Maintaining safe lung cancer surgery during the COVID-19 pandemic in a global city

Stephanie Fraser  1 , Ralitsa Baranowski  2 , Davide Patrini  3 , Jay Nandi  4 , May Al-Sahaf  4 , Jeremy Smelt  5 , Ross Hoffman  6 , Gowthanan Santhirakumaran  5 , Michelle Lee  2 , Anuj Wali  1 , Harvey Dickinson  7 , Mehmood Jadoon  4 , Karen Harrison-Phipps  1 , Juliet King  1 , John Pilling  1 , Andrea Bille  1 , Lawrence Okiror  1 , Sasha Stamenkovic  2 , David Waller  2 , Henrietta Wilson  2 , Simon Jordan  6 , Sofina Begum  6 , Silviu Buderi  6 , Carol Tan  5 , Ian Hunt  5 , Paul Vaughan  5 , Melanie Jenkins  5 , Martin Hayward  3 , David Lawrence  3 , Emma Beddow  8 , Vladimir Anikin  8 , Aleksander Mani  8 , Jonathan Finch  8 , Hendramoorthy Maheswaran  9 , Eric Lim  6 , Tom Routledge  1 , Kelvin Lau  2 , Leanne Harling  1   9
Affiliations

Maintaining safe lung cancer surgery during the COVID-19 pandemic in a global city

Stephanie Fraser et al. EClinicalMedicine. 2021 Sep.

Abstract

Background: SARS-CoV-2 has challenged health service provision worldwide. This work evaluates safe surgical pathways and standard operating procedures implemented in the high volume, global city of London during the first wave of SARS-CoV-2 infection. We also assess the safety of minimally invasive surgery(MIS) for anatomical lung resection.

Methods: This multicentre cohort study was conducted across all London thoracic surgical units, covering a catchment area of approximately 14.8 Million. A Pan-London Collaborative was created for data sharing and dissemination of protocols. All patients undergoing anatomical lung resection 1st March-1st June 2020 were included. Primary outcomes were SARS-CoV-2 infection, access to minimally invasive surgery, post-operative complication, length of intensive care and hospital stay (LOS), and death during follow up.

Findings: 352 patients underwent anatomical lung resection with a median age of 69 (IQR: 35-86) years. Self-isolation and pre-operative screening were implemented following the UK national lockdown. Pre-operative SARS-CoV-2 swabs were performed in 63.1% and CT imaging in 54.8%. 61.7% of cases were performed minimally invasively (MIS), compared to 59.9% pre pandemic. Median LOS was 6 days with a 30-day survival of 98.3% (comparable to a median LOS of 6 days and 30-day survival of 98.4% pre-pandemic). Significant complications developed in 7.3% of patients (Clavien-Dindo Grade 3-4) and 12 there were re-admissions(3.4%). Seven patients(2.0%) were diagnosed with SARS-CoV-2 infection, two of whom died (28.5%).

Interpretation: SARS-CoV-2 infection significantly increases morbidity and mortality in patients undergoing elective anatomical pulmonary resection. However, surgery can be safely undertaken via open and MIS approaches at the peak of a viral pandemic if precautionary measures are implemented. High volume surgery should continue during further viral peaks to minimise health service burden and potential harm to cancer patients.

Funding: This work did not receive funding.

Keywords: Lung Cancer; SARS-CoV-2; Thoracic surgery.

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Conflict of interest statement

None of the authors have conflict of interests to declare.

Figures

Fig. 1
Fig. 1
Catchment area of London Thoracic Surgical Centres. Dark grey area denotes regions covered by the pan London collaborative.
Fig. 2
Fig. 2
(a) Lung resections by surgical approach; (b) SARS-CoV-2 cases. (VATS: Video Assisted Thoracic Surgery; RATS: Robotic Assisted Thoracic Surgery).
See this image and copyright information in PMC

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